A rare presentation of Pott's disease with bilateral psoas abscess during pregnancy in a resource-limited setting: Case report from a resource-limited setting

Abstract

INTRODUCTION AND IMPORTANCE: TB remains a global health threat, especially in low-income countries. Spinal TB diagnosis in pregnancy is challenging, leading to potentially severe complications like psoas TB abscess. CASE PRESENTATION: A 30-year-old multiparous woman from Somalia region, Ethiopia in her second trimester of pregnancy who was diagnosed with isolated Pott's disease complicated by bilateral large Psoas abscesses. The diagnosis was made using lumbosacral X-ray, abdomino-pelvic ultrasound, and ultrasound-guided aspiration confirming tuberculosis. After she presented with a four-year history of chronic lower back pain, exacerbated by lower back and left lower quadrant swelling for six months, accompanied by constitutional symptoms. The patient was successfully treated with anti-tubercular therapy with no complication to her and her baby. DISCUSSION: Pott's disease with tuberculous psoas abscess is rare and challenging in pregnancy, often causing complications. Hormonal changes mask symptoms, delaying diagnosis. While Staphylococcus aureus is common, Mycobacterium tuberculosis is relevant in developing countries with limited diagnostics. Pott's disease constitutes 50 % of skeletal TB, with psoas abscesses in 5 % and rare bilateral presentations. Treatment involves safe, prolonged anti-TB therapy (2RH/10RHZE with pyridoxine), and delivery mode depends on obstetric factors. CONCLUSION: Pott's disease with TB psoas abscess, while rare, can occur in pregnancy despite immunocompetence. Early diagnosis in resource-limited settings and appropriate treatment are essential for good maternal and child health.